Home
About
Facts
Current Needs
Programs
Instrument Exploration Camp
Take 5 Jazz Improv Class
Live It OutLoud Summer Rock Camp
Music Therapy Groups
Donate
Events
Request an Instrument
Request an Instrument - Beginner
Request an Instrument - Step Up
Scholarships
TBM Program Scholarships
Music Therapy Scholarship
Contact
Music Therapy
What We Do
>
Individual Therapy
Online Therapy
Music Therapy Groups
>
Harmonic Connections
Lullabies and Laughter
Music Supports: Teens
Sprouting Joy
Schools
>
On Beat - SEL-Focused Music Therapy
Our Music Therapy Team
Blog
Subscribe e-newsletter
Request an Instrument - Beginner
Who is eligible: Any student between the ages of 8 and 18, and can demonstrate financial need.
Instrument Request Form - Beginner
*
Indicates required field
School Name
*
Instrument Requested
*
Flute
Clarinet
Trumpet
Trombone
Alto Sax
Tenor Sax
Percussion Kit (snare drum & bells)
Drum Set (standard 5 piece)
Violin 1/2
Violin 3/4
Violin 4/4 (full size)
Viola 13"
Viola 14"
Viola 15"
Cello 1/2
Cello 3/4
Cello 4/4 (full size)
Acoustic guitar
Electric guitar
Electric bass guitar
Other
(If Other Please Specify)
*
Parent/Guardian Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Contact Email
*
Phone Number
*
Please describe your financial need. Include household income and family size
*
Child's Name
*
First
Last
Age
*
M / F
*
Male
Female
Other gender identification
Prefer not to answer
Child Is:
*
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Prefer not to answer
Ethnicity:
*
Hispanic/Latino
Non-Hispanic/Latino
Prefer not to answer
Prior Musical Experience
*
Yes
No
Please describe how your child will benefit from their musical experience
*
How did you hear about Ted Brown Music Outreach
*
Submit
Form in Spanish
Instrument Request Form Spanish.docx
File Size:
127 kb
File Type:
docx
Download File
Instrument Request Form Spanish.pdf
File Size:
127 kb
File Type:
pdf
Download File
Downloadable form
Instrument Request Form.docx
File Size:
355 kb
File Type:
docx
Download File
Instrument Request Form.pdf
File Size:
201 kb
File Type:
pdf
Download File
Home
About
Facts
Current Needs
Programs
Instrument Exploration Camp
Take 5 Jazz Improv Class
Live It OutLoud Summer Rock Camp
Music Therapy Groups
Donate
Events
Request an Instrument
Request an Instrument - Beginner
Request an Instrument - Step Up
Scholarships
TBM Program Scholarships
Music Therapy Scholarship
Contact
Music Therapy
What We Do
>
Individual Therapy
Online Therapy
Music Therapy Groups
>
Harmonic Connections
Lullabies and Laughter
Music Supports: Teens
Sprouting Joy
Schools
>
On Beat - SEL-Focused Music Therapy
Our Music Therapy Team
Blog
Subscribe e-newsletter